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Home My Public Portal About4928 DOREEN AVE_Plumbing__ COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0404090023 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID: EES PAID BUILDING ADDRESS: TR: 13645 LT: 58 4928 DOREEN AV FEE DESCRIPTION:- QUANTITY: UOM: AMOUNT: TEMP CA 917804116 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: KEY WEST 8585-025-022 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: C4 LOCALITY: TEMPLE CITY, C 47 WATER HEATER(S) 1.00 WTH 16.20 TENANT: TOTAL FEES 43.95 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: 04/09/04 VG 10106/04 OWNER: TEL. NO: FINAL DATE - Y: CODE: EVANILLA MICHAEL S;KATHY M (626) 579-9882- 4928 DOREEN AV TEMP 917804116 DESCRIPTION OF WORK WATER HEATER CHANGE OUT APPLICANT: TEL. NO: ACTION CONTRACTORS (310) 515-1311- SPECIAL CONDITIONS: CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR S GNATURE ACTION CONTRACTORS (310) 515-1311- 17111 SOUTH BROADWAY LIC. NO UNDER SLAB WORK GARDENA CA 90248 B/L 27953 WATER SERVICE PLASTIC Y/N METAL Y/N ARCHITECT OR ENGINEER: TEL. N0: - ROUGH PLUMBING LIC. NO: GASPIPING GAS VENT HOT WATER HEATER PLUMBING FIXTURES LAWN SPRINKLERS GAS TEST UTILITY COMPANY NOTIFI D CWV GRAY WATER. SYSTEM * ADDITIONAL DATA ON FILE REPORT ID: DPR263 ROUTE TO: SS0508 I D.B.8A7 45M SETS 1196 APPLICATION FOR PERMIT DEPARTMENT OFNG AND SAFETY PLUMBING COUNTY OFF LOS LOS ANGELES • WM.J. FOX, CHIEF ENGINEER rR TURE OF INSTALLATION DISTRICT NO. GROUP zO E P RMIT O. ROUGHFIXTURES COMPLETE AV/ � CESSPOOL SEPTIC TANK REECEIIVED BY READY FOR DATEISSUED MISCELLANEOUS FIRST INSPECTIONA{PPL��I//C��A��NT FILLIN HEAVVILLY OUTLINED PnORTION ONL.Y�I/Jj/jU A`LC�"( �Y.�C+CX.'1 �_Ct�7YI I nADDREBB �iz 61leZl �i�sBLOCALITY ,/J.,�d„r r ii d TEL.NO.R 7( �' CR089 ST.�O. 7 Lf EXPIRES m NAME OF SEPTIC TANK, OR CESSPOOL = MAIL ADDRESS NORTH O CITY TEL.NO. I AM THE LEGAL POGBRSBOR OF THE ABOVE LOSANGELES COUNTY CCEERTIFICATE OF QUALIFICATION.eY ' PLUMGBR I AM THE LEGAL OWNER OF THE PROPERTY DESCRIBED ABOVE. > OWNER (•, ,r; . CORRECTIONS t) j SOUTH J DESCRIPTION OF WORK a z_ / BATH TUB FURNACE L'I I SHOWER DISHWASHER D AVATORY REFRIGERATOR •KITCHEN BINK WATER SOFTENER FLOOR BINK BAND TRAP GLOP SINK FLOOR DRAIN WASH TRAY URINAL APPROVALS WATER CLOSET DRINKING FOUNTAIN DATE INSPECTOR'S NAME WATER HEATER DENTAL LAVATORY ROUGH PLUMBING /, METER 'A GAB BOVA FOUNTAIN OUTL GAS PIPING I I GAB VENT ®® CEBGPOOL I TOTAL NUMBER OF FIXTURES SEPTIC TANK I CESSPOO, REPTICTANK SEWER I I / B TOTAL FEE �� 400 UTILITY CO.NOTIFIED FINAL �'�� O.B.5." 2SM5ETs 2-49 APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFETY. �� 7 COUNTY OF LOS ANGELES OUMBING WM. J. FOX. CHIEF ENGINEER NATURE OF INSTALLATION DISTRIc NO. GROUP ZONE PERMIT NO. ROUi GAHGH I� MIBCELLANE IUB I SEPTIC TANK RECEIVED BY DATE ISSUED READY FOR HEFIXTURES S ATER CEBHPOOL FIRST INSPECTION APPLICANT FILL IN HEAVIL_ OUTLINED PORTION ONLY B NAME C �(/ n ADDRESS EI ADDRESS 6 NT-IA,6 r7AA/ LOCALITY rlie Z — .// NEAREST y TEL.No. 11-,1 CROBB BT. Vli� COUNTY CERT.No. IXPIREB M0.• NAME LOCATION OF SEPTIC_TANK, OR CESSPOOL = MAIL ADDRESS O I �/ —�L/ NORTH O CITY TEL.No. I AM THE LEGAL POBSEBOO QF THE .ABOVE OS ANGELES COUNTY CERTIFICATE O LIFICATION.jF ON. FI:IIMBBR / 1 AM THE LEGAL OWNER OFVpTHE PROPERTY DE8C7BED 1sq ABOVE. 3 - VI }`. •. OWNER -1 CORRECTIONS ; 1 SOUTH J DESCRIPTION OF WORK Q _z BATH TUB FURNACE L7 RHOWER DISHWASHER D AVATORY ,„' REFRIGERATOR ' ITCHEN SINK � WATERSOFTENER FLOOR BINK SANDTRAP SLOP SINK FLOOR DRAIN WASH TRAY URINAL APPROVALS [-WATER CLOSET DRINKING FOUNTAIN DATE INIPRCTOR'O NAM[ WATER HEATER DENTALLAVATORY ROUGH PLUMBING I METER OAS SODA FOUNTAIN Op8 PIPING I I e k OUTL OAS VENT 1 CESSPOOL TOTAL NUMBER OFLFI�URES SEPTIC TANK I I �CESBPOOI CTANK SEWER I / I S UTILITY CO.NOTIFIED I;"�- I " TOTAL FEE FINAL ,TP1667 CES 17 5/70 � / .. APPLICATION FOR PLUMBING TPRMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUIILDIN JOHN A. LAMBIE. COUNTY ENGINEER r COLEMAN W. JEN KINS. SUPT. of BUILDING LOCALITY7� e FOR APPLICANT TO FILL IN (PRNT OA TYPE) NEAREST CROSS 57. NUMBER FIXTURE OR ITEM EACH FEE OWNER 7��0 WATER CLOSET BATH TU650 !, ADDRESS • SHOWER 1.50 CITY /�syJ / TEL. NO. LAVATORY 1.50 CONTRACTOR SINK 1.50 ADDRESS 7 l DISHWASHER 1. CITY ��7 TEL. NO. 22M LOTHES WASHER 1. 0 STATE LICLICENSE NO. CLAS SWIMMING POOL RECEPTOR 1.5 DISTRICT NO. i GRO Z77 PR ,C�S$Em BY' LAWN SPRINKLER SYSTEM 2.0 �} arj/ WATER HEATER LNDUS7RIAL / WASTE APPROVAL Q GAS SYSTEM OUTLETS '1.5 INSPECTION RECORD U OUTLETS OVER 30 5 PER SYSTEM WV O. H Plan check fee 2.S% of above. See reverse. r PLUMBING PERMIT ISSUING FEE 8 00 TOTAL FEE APPROVALS DATE Ir sPecT Si"ATURE Plan check applicant UNDER SLAB WORK �� G Name ROUGH PLUMBING Address GAS PIPING GAS VENT City Tel. No. HOT WATER HEATER I HEREBY THAT ACKNOWLEDGE THAT I HAVE READ THISGRE APPLICATION ANO STATE THAT THE ABOVE S CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES WITH ALL COVNTY ORDINA S AND STATE LAWS REGULATING GAS TEST PLUMBING. 1 HEREBY CERTIFY THAT 1 M PROPERLY REGISTERED AND/OR UTILITY CO. NOTIFIED LICENSED AS REQUIRED BY S ANGELES COUNTY A D STATE F CALIFORNIA OR THAT 1 AM E LEGAL OWNER O. D INTE TO' RESIDE IN, THE ABOVE DES BED REBID NTIAL P RrY. FINAL SIGNATURE JACK R. ALLEN, SUPERVISING ECHANICAL ENG'R. OF PERMI EE PERMIT VALIDATION CH � }+.o. CASH PLAN CHECK LIDATION crc. M.o. CASH Li�02692» uCi 5 D 1 8.75- s ^• �' ,WORKERS' COMPE NSATION1 DECLARATION, ` - r �-. I herebyNfflrm thzt'I have a certificate of consen :s igoelf in 202D00260046W 4,17] .APPLICATION FOR. PERMIT * 4 DPW - - sure,or Aertifimte of Workers'Compensation Insurance,or a 76ACE 67(REV. B/86) certified copy'rhereof (Sec. 3800 Lab {r) - . -Policy No. Compgnyt- ' ' . COUNTY OF'LOS ANGELES',..,' DEPT. OF PUBLIC WORKS Certified'.copy is�herebyfurnlshed'. NG FOR APPLICANT TO FILL-IN (PRINT OR-TYPE): BUILDICertified copy is filed withthe coumy building mspe8ion' - - ADDRESS aL B department. .` -. NUMBER FIXTURE:OR ITEM @ FEE q��[g��E LOCALITY - Dated Applicant, WATER CLOSET,(TOILET) NEAREST . -- ',CCE CERTIFICATE BATH TUB CROSS�ST. CERTIFICATE OF EXEMPTION OM'WORKERS' - _ - 'COMPENSATION INSURANCE' > - - SHOWER - OWNER r r. (This section need'not'be completed,if the work involved:by - MAIL - the permit is for one is dollars (2100)or less.) L"AVATORv - ADDRESS I certify thahin'the performance of the work for which this per- SINK CITV' TEL NO. - mit is i ssued, Ishall not employ any person`in any monner'so as to become subject,to the Workers' C6rdTsatiom Laws. ' DISHWASHER CONTRALTO Date Applicant"` ' -. CLOTHESWASHER ADDRESS //�� NOTICE TO APPLICANT: If,'after making this Certificate of Ex- - /Vr AO enation, you should become subject to the Work 'Cen- SWIMMING POOL RECEPTOR, p - jecWorkers' lotion provisions atone this Code ,you forthwith comp- e tNgWSPRINKLER'SYSTEM TEL. or thmust _ !/+'li ly with such provisions or is permit shalt 6e deemed'revok- ^ STAVE 41C. ' ed:_' " - WATER HEATER 00 LICENSE NO. CLASS' LICENSED CONTRACTORS DECLARATION- DISTRICT NO ROCESSED BY I hereby affirm th'dt I amilicensed-under provisionsQ of Chapter' GAS SYSTEM' :OUTLETS 9(commencing with Section 7000)of Divisiom3 of the Business OUTLETS.OVER and Professions Code, and my license is in full force ond'ef- 5 PER SYSTEM FINAL fact., >. tett:. - DATE.. IL O License Number ��r_�7l Lic. Class ��—C, ' O - FINAL Contractor ' C_ Date 0 O' _ BY O f U .� ban exempt oder Sec .. - W 6.8P.C.'tor this reason 4 D • Plan check fee W �- �- � _ s. Date.' a PLUMBING PERMIT ISSUING FEE $ y Signature I _ .. TOTAL FEE. - t t „ ' SINGLNFAMILY `-I HOME-OWNER BUILDER DECLARATION Plan check`.appli cant• ro <t S hereby affirm that am ez' 'pt from the Contractor's License Name Low for the,following reason (Section 7031.5; Business and - - T + Professions Code): - Address - _` ACCI.r - 33117 22.% I;?-as owner of the property wilbdo the work and the City >;Tel.No. 1 ITEMS r structure is not intended orEoffered far sale(Section 7044, -9 n _ - ` Business and Professions Code) •1 - - ® ` TOTAL 27 50 CONSTRUCTION LENDING AGENCY CHECK 22.50I hereby affirm that there isia construction lending agency for - - , the performance of the work far which'this permit is`issued' 00 ,(sec..3097;Ci,. c.). - - -..CHANGE .. .. Lender's Name: - i . } rn 000Q- 1. .... .g/`?CU�9 Lender I's Address 53181 Mi A 0:51 certify that•I,fiave ad this application and state that the abovelinformation" correct. l agree to comply with all County - ordinances an St to laws regulating Plumbing, and.hereby oath rize re s ntatives of th Is,County to enter .upon the - ^ - abov en o pro coon p`}poses. - r SEEAEVERSE.FOR EXPLANATORY LANGUAGE r Signatur ern Tote ate